Commentary

Bleeding control is a key step during endoscopic submucosal dissection (ESD). Identification and precoagulation of vessels is ideal, but when bleeding occurs, a rapid and structured response is critical. Accumulated blood can quickly obscure the dissection field – especially in underwater conditions or gravity-dependent locations. This video emphasizes the fundamental first step in managing active bleeding: precise compression using the distal cap (as bidigital compression is the first step for epistaxis control), combined with generous irrigation, to restore visibility and buy time for hemostatic intervention. The second step involves progressively releasing pressure while carefully maneuvering the endoscope to localize the bleeding vessel. This everyday technique should be mastered and taught to avoid blind coagulation. However, pressure intensity must be controlled, as excessive force may risk mechanical perforation, particularly in fragile areas such as the sigmoid or duodenum.

Publication History

Article published online:
29 July 2025